Forequarter amputation for recurrent breast cancer: A case report and review of the literature

Abstract

Axillary recurrence of breast cancer is an uncommon event that can lead to debilitating pain, lymphedema, and paralysis of the upper extremity. Multimodality therapy including surgery is usually used to control local recurrence. In a subset of patients, the extent of disease is such that local excision of the recurrence is not possible. In the absence of metastatic disease, forequarter amputation may be used as an effective means of surgical salvage and palliation for locally recurrent breast cancer. In this report, we describe management of a patient with advanced axillary recurrence treated with forequarter amputation and review the current literature on the use of this operation in breast cancer patients.

Extensive Cutaneous Metastatic Breast Carcinoma of the Hand and Upper Extremity: A Case Report

“…5,6 Forequarter amputation for palliative treatment of axillary chest wall cutaneous metastasis of breast carcinoma has also been reported by Wittig et al, 4 Pressman, 13 and Holleb and Lucas. 3 Goodman et al 14 reported a 35-month disease-free follow-up period in a 56-year-old woman with recurrent breast carcinoma to the cutaneous tissues of the axillary region who was treated with forequarter amputation. This patient presented with a 7 ϫ 7-cm necrotic mass in the cutaneous tissues of the left axilla.…”

Forequarter amputation as a life-saving procedure

“…Traditionally, forequarter amputations were most commonly performed for high-grade sarcomas of the proximal humerus, scapula and axillary region with neurovascular involvement [1][2][3]. Today, the most common indication for amputation for these tumours is failure to respond to induction chemotherapy and/or tumour progression, with vascular or brachial plexus invasion [4].…”

Simultaneous forequarter amputation and radical mastectomy for metastatic breast carcinoma in a male patient: a case report

“…Although the majority of forequarter amputations are performed for high-grade bone and soft tissue sarcomas or extensive osteomyelitis of the upper extremities, this radical operation may also be indicated for the curative treatment of recurrent breast cancer and for the palliation of locally advanced breast cancer [4]. Axillary tumor recurrence may cause significant morbidity due to pain, limb dysfunction, lymphedema, and varying degrees of paralysis and sensory impairment [3,4].…”

“…Axillary tumor recurrence may cause significant morbidity due to pain, limb dysfunction, lymphedema, and varying degrees of paralysis and sensory impairment [3,4]. It may also cause chest wall invasion, and skin ulceration secondary to invasion of the brachial plexus and axillary vessels by the tumor [3,4]. Further morbidity can be caused by perforation of the overlying skin by the tumor causing bacterial or fungal infections, sepsis, or hemorrhage.…”

“…All of the cases were females and only 4 of these amputations were performed primarily for curative purposes [4]. We are hereby reporting a male patient with metastatic breast adenocarcinoma who underwent simultaneous modified radical mastectomy and forequarter amputation.…”